Episode 45: Jim MacKenzie D.O. Psychiatrist

Today, we will be speaking with Dr. Jim MacKenzie, a child psychiatrist in Chicago. Dr. MacKenzie graduated from the Kansas City University College of Osteopathic Medicine. He then completed his residency in psychiatry at Loyola University followed by a fellowship in child psychiatry at Lurie Children’s Hospital in Chicago. He went on to practice academic medicine, but recently transitioned much of his time to focus on political advocacy. He is currently working to expand the scope of practice of family medicine physicians to include psychiatric care. As you will soon see, Dr. MacKenzie demonstrates how intelligent and thoughtful psychiatrists can be. If you have not previously considered a career in psychiatry, I know you will be inspired to reconsider after listening to his interview about topics ranging from autism to how a pizza party changed his life.

Hosted by Madli Vahtra 
Edited by Celine Tran

Transcript

My name is Dr. Ian Storch.

I'm a board certified gastroenterologist and osteopathic physician, and you are listening

to DO or do not.

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us at DoOrDoNotPodcast.com.

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We hope you enjoy this episode.

Hi, my name is Madly Vatra.

I'm a third year osteopathic medical student, and you are listening to DO or DO NOT.

On today's episode, I'll be speaking with Dr. Jim McKenzie, a child psychiatrist in

Chicago.

Dr. McKenzie graduated from the Kansas City University College of Osteopathic Medicine.

He completed his residency in general psychiatry at Loyola University, followed by a fellowship

in child psychiatry at Lurie Children's Hospital of Chicago.

He then went on to practice academic medicine and recently has transitioned much of his

time to focus on political advocacy, working to expand the scope of practice of family

medicine physicians to include psychiatric care.

As you will soon see, Dr. McKenzie demonstrates throughout his interview how intelligent and

thoughtful a psychiatrist can be.

If you haven't considered a career in psychiatry, after listening to his interview about topics

ranging from autism to how pizza party changed his life, I know you will be inspired to reconsider.

Thank you again for coming onto this podcast.

We're all really excited to have you tell us about your life and how you became a child

psychiatrist.

I'm going to start the interview off by asking, where did you grow up and what was your family

like growing up?

Wow.

Let me think.

I grew up in Minnesota and you might hear an accent, hopefully not.

Sometimes if I talk too much, you can hear it.

I grew up in southern Minnesota, in Rochester, Minnesota, where people associate the city

where the Mayo Clinic began.

And that's clearly, it's undeniable, it's been a part of my influences of going into

it.

But I'm a Minnesota boy and rather than go back to Minnesota after training, you can't

help but think as a kid that you will someday.

But I ended up becoming a psychiatrist and as most folks would probably easily assume,

it's probably best to train in a big city and to work in a large urban environment.

There's just a lot more going on.

I'm sure the medical students or those learning about medicine in general have heard of the

urban drift theories and some folks that have chronic mental illnesses for whatever reason

are drawn to large urban areas.

So rather than return to rural Minnesota to live and to work, I found myself training

in Chicago and then staying here.

What got you interested in becoming a doctor in the first place?

Yeah, so undeniably.

And when I say Rochester, Minnesota, to me, it's a town of 35,000 people, which I know

is not a small town.

And I say that because now I'm living downtown Chicago.

So every once in a while, I'll have a friend that will correct me and they'll say, that's

not a small town.

When I grew up in Rochester, Minnesota, maybe 50,000 people and now there's over 100,000.

It's become a much bigger city and there's a branch of the university there and such.

But when I was growing up, the entire skyline of my hometown was hospital buildings.

And so if you could imagine, yeah, it's really an interesting thing.

There's an actual skyline.

It's like a mini Chicago, maybe 10 buildings, but every one of them is a hospital building.

And if you haven't been there, it's worth seeing or at least Googling it.

There's a small city with hundreds of operating rooms, a medical surgical center.

In my humble opinion, it's the best hospital in the world, started by primary care doctors

after a tornado.

There's a really neat story behind it.

The city in which I grew up, the entire city was focused towards medicine.

There was an IBM plant on the north side of town, but most folks there at the time when

I was growing up worked for the hospital or supporting businesses.

So it's undeniably that's going to play an effect for better or for worse, I might add.

Because if I look back at my life and I thought, well, to be a successful person, I have to

become a doctor.

You know what I mean?

And I don't regret anything about it.

I have an interesting story that when I moved into my condo building where I live now, and

by the way, I'm just a regular Joe bachelor living in a one bedroom condo here in Chicago,

and I'm considered the poor doctor that lives in the condo as my home, as opposed to all

the financial people and very well-off, wealthy people.

I'm one of the people that actually lives here as my home, as opposed to a vacation

home or a third home, right?

So what I've come to realize in my life, you do not go into medicine for money.

If you want to make money, we are all doing this wrong.

You go into financial work, you go into banking and stuff like that.

And that was something that was really new to me when I moved to Chicago.

Now that I've lived here for a while, I've become aware that physicians don't starve,

but they're not rich, you know, and nor do they want to be because it doesn't make financial

sense to go backwards in the hole with your student loans and then not to make a decent

paycheck for a decade, and then you're in a race to pay off your loans.

But to me, growing up, that's how you make it.

And it was either you become a physician or, and this was gender-biased because this was

in the 80s, it was either become a physician or you play professional hockey.

And I couldn't play professional hockey, but a lot of people in my high school class did.

In fact, there's a guy with my same name who played for the Hartford Whalers.

So I thought that was further evidence that it's not my turn, that somebody else is already

doing it with my name.

So I just found myself dwelling in medicine.

So where did you end up going to undergraduate school?

It's so funny you say that because I was going to segue to that.

So if you grow up in Minnesota, and there's a lot of nice undergrad schools there, and

I ended up going to the university, to the big University of Minnesota in downtown Minneapolis,

and they have an amazing undergraduate and graduate program for psychology.

Now I'm a psychiatrist, so I did the medical route, but this also plays in big time into

my life, and the moment that I thought about for sure, when you grow up, what do you want

to be when you grow up as a little kid, I'm going to be a doctor.

And oh, by the way, I should have mentioned this earlier, I apologize.

My father is a DO, and my father just retired from a almost 50-year career at Mayo Clinic.

And my dad's a DO, just like me and many of the others on their way to becoming DOs.

My dad, class of 67 from the Kansas City School, he's a DO, and I'm told he was the first

DO on staff at Mayo Clinic.

So I hope someday maybe you can talk to my dad or other people that will get a chance

to talk to him.

Yeah, he blazed the trail, and if you think, and forgive me if I'm jumping ahead a little,

if any of your questions today have to do with like stigma or YMD or YDO, it's people

like my dad, and obviously I'm biased, it's my dad, but there's people many, many years

before me and those of you who are currently in school.

People broke barriers for us many, many years ago.

And as people like my pops, we have to think, but I digress.

But so I was at the University of Minnesota where they have this amazing undergraduate

and graduate program for psychology.

And I was trying to decide between being a psychologist and a psychiatrist.

I wasn't sure.

And as all the students know, as you've had to learn in your second year, your pharmacology,

you learn about the different antidepressants.

And as those of you who are considering medicine and maybe haven't yet decided what you want

to do, these are both amazingly fun and rewarding careers.

They're psychologists that have a graduate degree, you get a PhD, and you write a paper.

And if you want, you could do clinical work or do research, and they're amazing people.

And I was doing that for my undergrad major.

And then across University Avenue at the medical school side was a little pizza party that

was going on one day and as a starving, what am I, 20?

And I wanted some pizza and then I tried to blend in and I went over and I ended up serendipitously

hanging out with psychiatry residents having a pizza party.

And this became a founding, I mean, it's really pathetic.

Other people have these amazing life stories.

And then I discovered the cure for the enzyme was right in front of me.

Not me.

Mine was a pizza party.

Pizza is generally the answer to a lot of good things in life, so I was sharing pizza

and I was speaking to a young man.

If I had a time machine, I would go back to find who was this young man at the University

of Minnesota who was a psychiatry resident.

And for those that are thinking about medicine training, a resident is after you're done

with medical school, but you still have a few more years to complete your training in

that field.

You're a doctor, but you're not all the way done with all of your formal training and

your final certification test.

And as I say that, I realize there's a very popular TV show called Resident, probably

everybody already knows that.

But so I was hanging out with psychiatry residents eating pizza and I said, hey, what are we

celebrating?

And they said, well, there were people at the university that were involved in some

of the successful early trials of the serotonin reuptake inhibitors.

And that would be like fluoxetine.

Brand name Prozac came out, shows you how old I am.

So this had just come out.

And as I'm shoving pizza into my mouth, I said, so is that better than therapy?

And I thought for sure, this is a physician.

I thought for sure as a naive college student, I thought this person would say, yeah.

And he said, no, it's not any better than therapy.

In fact, we think they're roughly the same.

So if you do therapy, this could help.

And if you take this, you know, you might want to consider also doing therapy.

And that's been later proven many, many times in very, very large landmark studies in psychiatry

that it's been proven for anxiety and for depression within kids, within child and adolescent.

I'm sure there are studies for adults, too.

But I thought that was so neat that here a young doctor told me, no, no, we're celebrating,

but we're not even saying it's better than talk therapy.

And then I said, oh, so this is a newer medicine.

He said, yeah.

I said, oh, so this is better than the old stuff.

He said, no, it's not better than the old stuff.

In fact, it might not be as good as the old stuff.

And I looked at him and I said, well, then what the heck are we having a party about?

He said, this is safer.

And that was earth shattering to me.

That was when the light bulbs all clicked.

I said, we're celebrating safer medicine.

He goes, yeah, that's what medicine is all about.

I liked that.

I liked that a lot.

So when you see an ad on TV, you will often hear the commentators say in that deep, quick

voice, tell your doctor if you take an MI.

They quickly slide that in.

What they're talking about is the old, old generation of antidepressants, monoamine oxidase

inhibitors.

It's a different way of increasing serotonin.

So these newer medicines do it, but the MAOIs did it in more of a non-reversible way and

they had dietary restrictions and they could be lethal in overdose.

So here we had a new class of medicines that was simply safer.

And I thought that was so cool.

And I went back over to the graduate school to kind of do, I was doing those volunteer

research projects that we all did in college that had a cooler sounding name than you then

actually describes.

I was probably making copies, but I was called a research assistant, you know, and the one

wonderful graduate student that I was with said, hey, where'd you get the pizza?

And I told that story.

And she said to me, you know, if you like that stuff, why don't you go to medical school?

And to this day, I don't know if she was being sarcastic because I was almost about to graduate

from college or if she meant it.

But that's what I did.

So the choice of, and forgive me, but that perhaps is your next most logical question

would be then why did you think of a DO school?

That's exactly my next question.

You had mentioned that your dad was DO.

So did that play a factor into things?

Yeah.

So roughly at that time of my life, there was a reunion at my dad's school.

So young people can thinking about maybe a career medicine.

So not every state in the United States yet, eventually I hope they do, but not right now

are there a DO school in every state.

So in Minnesota, when I was in college, and I don't believe there still is, there was

talk of one coming, but I don't think currently there is one.

So if I went to the pre-med advisors at the University of Minnesota to talk about becoming

a physician, they would say, oh, well, the MD school is across the street where they

have the pizza parties.

But what I wanted to know was what the heck is behind my dad's name?

What's this DO business?

And it's really interesting because my dad is a retired anesthesiologist and one of his

jobs was scheduling people in the operating room, the staff, to make sure which anesthesiologist

is in which one of the hundreds of operating rooms at this large medical center.

And I thought in my ignorance, and I'm going to tell this story because it's terribly embarrassing

to me, but I want other people never to be in the situation.

I thought that his DO meant like director of the operating room or I didn't even know

what it meant.

I just knew that there's every department at Mayo seemed to have a DO.

So I thought that was like a team leader, you know, like, oh, hey, this person's like

an MD, but then you take a little extra training like an MBA or, you know, I just thought it

was something that had to do with like logistics.

That is the dumbest thing.

Everybody that is not what a DO is.

But that's what I thought they were because there isn't a DO school in Minnesota.

So how was I to know?

And the pre-med advisors didn't tell me about it.

So being a DO for everybody considering, it's the coolest thing.

You're an MD for every sense of being an MD.

You do what they do.

We take very, very similar training.

In fact, I did two residencies in MD hospitals and I can tell you about that.

But what's neat about them is we have related, but different holistic approach to patients.

My dad is one and I couldn't tell the difference and I thought it was something else.

But I thought, well, if I'm going to go to school, might as well go to the same school

my dad did.

And we used to joke, well, you know, none of us will be known for anything, but maybe

they'll name a bathroom after us or something, you know.

So why not?

If you're going to apply to a bunch of schools, why not go to somewhere where your parents

may have gone?

So my dad had a reunion, his medical school class had a reunion, and I tagged along.

And when they were all at the dinners and just, you know, hearing the lectures and such,

I went over and talked to the advising office.

And I recommend that for folks.

When medical students have asked me, hey, when I apply for residency, what's the best

thing that I should say and do for program A, B, and C?

And something I've learned now 20 years after I graduated from DO school is you ask the

program.

Call them.

Ask them, ask them specifically, hey, I want to come here.

What do I need to do?

And I did that.

So I met with an advisor and they looked at me like I had two heads.

I think because people don't do this, I just showed up.

I made an appointment and came in and sat down and said, hey, I don't have enough pre-med

classes yet.

And it took me a couple years after graduating to get all my pre-med classes to take the

MCAT.

But I said, how do you do it?

Because in my state, there isn't a DO school.

I want to know what to do.

So he talked me through, wrote them all down on a piece of paper.

And something I'm very proud to say that I did was I carefully folded that piece of paper

up with a list of the classes and the MCAT scores.

And a year and a half later, I was in front of that same person with his sheet of paper

with little check marks after each of the things he told me to do and I had done them.

And I said, now what do I do?

And he looked at me and he said, well, this might be your biggest dream or your worst

nightmare.

And I said, what do you mean?

He said, well, you're doing well and I think you'll probably get in.

So buckle up.

And sure enough, I ended up getting in.

Why DO was because of my dad.

I know that.

And I didn't understand at the time what it really meant until our school started.

And I'm just going to shift gears a little bit and talk about your medical school experience.

What medical school did you end up going to?

So Kansas City, Missouri.

And as folks that are currently DO students, by the way, I think of a DO in training as

a DO right now.

I mean, we are siblings.

The fact that I was born ahead of you or somebody else is a couple years head start on you doesn't

change anything.

We're colleagues.

So forgive me.

I mean, students and me and my dad, all of us.

So as everyone can relate that is in training at a DO school, our names of the schools have

changed.

It's because we've added in different programs like a PA school or a pharmacy school.

So most of them used to be the name of the city and then College of Osteopathic Medicine.

But now they've turned into universities because they have several different programs.

However, my personal rather childish opinion is because the names of the school ended in

COM from 100 years ago.

So my dad graduated from KC COM.

And when I was there, I had a different name.

But if I wore my sweatshirt from the school and it ends COM or when I had like a document

from my school, I've had patients and their families say, oh, wait a minute.

Did you go to an online medical school?

I'm like, no, that COM is from hundreds of years ago, way before the COM.

So I know that's not the real reason, but it is kind of funny to think about.

So your school, CCOM, nobody calls it, or they still do, but we're trying not to.

And it's funny because the general public don't stop to think about it.

When they look at that, I guarantee you, whether we admit it or not, they think you went to

an online medical school, heads up.

But anyhow, it's what is it now, Kansas City University of Health and Biosciences, I think.

It's changed the name several times since I've been there, which is a debate in itself.

Do you keep the current name on your CV or not?

It gets confusing.

I try to, but yeah.

So I went to the Kansas City.

When you were in medical school, did you decide to write the USMLE in addition to the COMLEX

exams?

I think that is such an excellent question.

What I did was I was a terrified student who, like many of the folks listening, maybe you

can relate.

I had just gotten done taking my pre-med classes and I could get an A and I would make sure

I had the highest score in organic chemistry.

You work your butt off and you get these great grades and suddenly you're in a class of 150

other people.

Every single person there was the straight A student at their respective school, right?

So on the car, I turned off the high beam headlights and I switched them to the regular

beams and I thought, okay, I can't compete with everybody here.

I'm going to try to pass, right?

So I shifted gears to pass everything, do well, just stay in the middle of the class,

man.

Just pass everything.

So there's an old term called gunners and I'm sure that's still around and those are

the people that continued to need to be number one at all times and were just very, very

competitive with each other.

And the gunners at my school told everybody that the COMLEX is going to become by way

of the dinosaur and anybody that takes only the COMLEX, you're never going to get a residency.

And I told that story to my dad and my dad laughed and he said, yeah, I remember people

talking about that in the 60s and 70s.

I think there's a rumor.

If I'm rudely making an assumption that maybe you're asking me that because that rumor still

exists to this day.

And if you take 150 people, put them in a room and start a rumor and they're nervous

people, you know, because it's a competitive situation, rumors fly and they go quickly.

You know, I'm 20 years out and I spent most of my career working in academic medicine.

And again, it goes back to my very humble tip that I would offer to any trainees.

If you're thinking about becoming an XYZ specialty physician and you're wondering should you

take the COMLEX or USMLE, I strongly recommend don't take it from me.

I mean, I'm going to give you my thoughts, but don't take it from me.

If you want to go to, I'm making this up, you want to become an orthopedic surgeon and

you want to go live in Des Moines, Iowa, because that's where your family's from or whatever,

then what you do is you call that university hospital, you talk to the program director

and you say, hi, my name is Bob Smith.

I am a medical student.

Do I need to take the USMLE or the COMLEX?

And what they're going to tell you is what you should do.

However, that said, when I spent most of my career working at a very large children's

hospital downtown Chicago with a Northwestern University faculty appointment and the program

director where I was a faculty member said, DOs take the COMLEX, MDs take the USMLE.

We know what to do.

We know what a COMLEX is and the program directors that I have come to know in my life and I've

met them at Mayo and at different universities in Chicago and I once visited with Harvard

Medical School and had this talk with them and it's almost insulting to imply that a

program director, this is what these people do, their primary job duty is recruiting medical

students to their residency.

So that person is a specialist in understanding post-graduate medical education, right?

They know what the COMLEX is.

Now, does that mean there are programs that would rather have the USMLE?

Certainly, I think in my opinion it's an artifact of some residencies are extremely competitive.

So it's not that they're against DOs, it's just that they have four spots and they've

got 500 applicants all from Mayo Med School or Harvard Medical School and it's not that

they're against the DOs.

They've got more of their own MD graduates from their own institution, they don't even

get past page one of their applicants, you know?

But be careful because I really do think that's one of those stress-based decisions and my

classmates that some of these are my very, very best friends in the world, some of my

friends started to take the USMLE and the COMLEX.

So if you start to do that, realize that unless you continue that series and take step one,

step two, step three, you either you're going to do it all or you might as well not do anything.

The people that I know that started to take both realized they don't need to take both

and they stopped.

So now why did you do step one USMLE in addition to the COMLEX?

You know what I mean?

That sort of stuff.

So anyhow, a simple answer to that is call the program in which you would like to apply

for your residency and ask them.

If they say take it, take it.

Your question is so good.

I get asked that every year when I go talk to the students, but also maybe once a month

by a friend's son or somebody, you know, I get asked that all the time, all the time.

You had mentioned earlier that your father was an anesthesiologist, was that a specialty

that you were ever considering or was there anything other than psychiatry that you ever

thought about pursuing?

Right on.

I'm kind of smiling at myself too.

Every psychiatrist knows don't dwell in stories of your own father, right?

You mean this sounds kind of creepy.

However, there's a story that must be told because it has an undeniable impact.

So I went to medical school because of that pizza date and I thought this is cool.

I really think this would be fun to learn about these medicines and I really liked how

that psychiatrist made it clear he was not trying to put down psychologists at all.

He was saying this is safe and if you combine these two aspects, you can really help people.

I thought that was great.

So I go to school and I'm thinking, now that's pretty neat.

Now I'm surrounded growing up by Mayo Clinic physicians, surgeons, endocrinologists.

Our holiday dinner parties were just the coolest.

I didn't realize it at the time.

I just thought everybody is like this, but the people at the dinner tables occasionally

would just the stories were unbelievable from the medical especially.

So I thought they were all neat and I know that's a problem that haunts students now

is because it really is cool.

There's so many amazing specialties that we all could do and all could enjoy and at some

point you have to pick one and that is not fair.

But fact of the matter is we don't live long enough to get to do more than once.

You have to pick one.

So I knew that I really enjoyed it, but what I was enjoying wasn't so much one specialty

or another.

I was enjoying the collegiality between physicians and thinking how cool it was to hear an endocrinologist

talk about their cases and their studies and then hear an anesthesiologist talk about,

oh yeah, well, I've seen that in this other setting.

Because of the exposure growing up, I knew that whatever kind of a physician I became,

I'm going to need to have interaction with other types of subspecialties.

And that's something for those of you out there who are debating between, I'm just going

to make this up.

I really like kids.

I think I'd love to be a pediatrician, but man, the ER rotation was great.

I don't know which one I should do.

Well, pick either one you want.

You can become a pediatrician and then later work in an ER or you can become an ER physician

and then specialize in kids.

There's always more than one way to do this.

So I went in thinking to be a psychiatrist and then in my third year, so imagine you're

me right now and here on your surgical rotations, your father becomes the president of the American

Society of Anesthesiologists.

So now you're in a hospital, your dad's a DO, you're in DO hospitals, I did my rotations

in Detroit.

It had a blast.

One of the neatest things ever.

My school was in Kansas City, but there weren't enough med students in Detroit.

Long story short, Detroit just said, hey, if any of the students in the Kansas City

School want to do something fun, because not everybody could do it, like if you had a family

or your kids were in elementary school, but my two buddies, you know, we were the three

amigos and we're all single guys and I don't even think we owned a plant, like so we could

have lived, so we all went off to Detroit and had a really good time.

I was just where you are right now and I was in a little DO hospital and just outside of

the city itself and my dad had won an election to be the head of the American Society of

Anesthesiologists.

Now, am I bragging about my dad here?

Yeah, I'm very much bragging about my dad because that's not the DO group, that's not

the MD group, that's all of them.

That's the national anesthesiologist.

That's pretty cool.

Now we have a DO pushing boundaries and this was in the year 2000.

Okay, so now I'm a third year med student on my first rotation in surgery and an anesthesiologist

walks by in the cafeteria where I'm grabbing a coffee before I run up to see patients and

said, hey, wait a minute, hey, is your dad who I think he is and yeah, next thing you

know they're dragging me into the operating room saying, hey everybody, look who's here

and they would say, hey, you want to innovate the baby or hey, we have a really rare case

of try to do that and people assumed therefore that's what I must want to do, but I didn't

want to do that.

I still was interested in being a psychiatrist and I didn't want to tell people that because

I didn't want to take the stigma, I wanted to fit in with every rotation that I was in

and I didn't.

The stigma against mental health is severe and it's getting worse and it was bad enough

for me that I was too chicken to start a psychiatry interest group as a medical student and at

your school, I remember it feels like yesterday so it means it was probably a decade ago,

a young man got a hold of me and said, hey, I'm thinking about starting this, would you

come out and talk to us and I thought that was the coolest thing I'd ever heard because

he had the guts to start that organization for, you know, at your school.

I didn't have the guts to do it.

Yeah, so there was a time when I thought, you know, it would be maybe an easy path for

me, not that becoming an anesthesiologist, I'm not smart enough, I'm not skilled enough

and I didn't want to do it because I knew I wasn't good enough so it wouldn't have

been good for me or the patients, but I think it would have been easy to get, obviously,

to get interviews, you know what I mean, to pull a string or to something like that, but

I didn't want to do it.

I had no interest in becoming an anesthesiologist.

You know what's funny?

Looking back, again, just as a concrete example of how you can sleep at night if you're thinking

between a couple of different specialties because a few years later, as everybody might

know, there's something called a pain fellowship and so neurologist, anesthesiologist, psychiatrists

can take an extra year training and become certified in pain management.

So had I really wanted to do it, I could still do that one more year and then find myself

working in pain, you know what I mean?

But one thing I want to slide in real quick is speaking of pain, this is one of my I'll

never be known for anything either, but this will be one of my little post-it notes, little

pearls of I don't want to call it wisdom because it's probably not that smart.

It's just an observation I've made in my life.

Pain, my dad's an anesthesiologist who treated pain, right?

That's what they do.

A psychiatrist, what do I treat?

I would say I treat pain.

So when anesthesiologists would ask me, hey, given that your father just retired from a

career in anesthesia, when you were a medical student, did you think of it?

And I said, no, I wanted to treat pain.

So I did not go into anesthesiology.

I went into psychiatry and I will say that to the face of any anesthesiologist.

Now their job is incredibly challenging, incredibly challenging.

You bring your patients to the edge of death, then they're being operated on, then you got

to wake them up.

I mean, that's terrifying stuff, right?

I think they're the doctor's doctor, they're amazing.

But what they're doing is socially acceptable.

If you're going in for heart surgery, if you're a kid, your whole school stops and they make

prayer shirts and, you know, make-a-wish shows up, Jennifer Aniston flies in from out of

town, the teddy bears, there is nothing more socially accepted than a body illness, right?

Think about psychiatry.

Think about a kid that's depressed and cuts or tries to commit suicide.

The stigma against those people, they don't even want to ask for help.

I mean, think about that.

So anyhow, I digress and I'm not trying to be like overly, you know, mushy about this,

but in a way, I say that psychiatry is the real anesthesiology because I say we treat

pain.

So for those of you who have not been bored by this story, the nutshell is when I was

a third-year medical student late at night in an emergency room, there were two patients

left in a community hospital and a patient was brought in by the police for she was thinking

of committing suicide and was kind of cast off to the side of the emergency room and

left in her street clothes and she sat on the side of the emergency room while they

tried to figure out how to call a psychiatrist to figure out what to do.

And everybody was awkward and just nervous and nobody knew what to say and all these

urban legends of, geez, if we ask about suicide, is that going to make her do it?

You know, there's all these bizarre thoughts and everyone was saved because a little boy

was brought in with a hurt foot from a soccer game earlier that evening and that gave everybody

something to do.

So the entire emergency room, everybody found a reason to go talk to the nine-year-old with

a twisted ankle and whatever it was, the boy needed to have some type of a plaster cast

put on his foot and what happened next was everybody in the ER started to sign this cast

and I was having one of those, I've probably had three moments in my life that are kind

of profound.

I don't have that many but this was one and as I sat there, I could see the lady who was

suicidal by herself and I saw 30 employees in the emergency room surrounding a boy signing

the cast of someone they don't know and I thought to myself, that's society.

It's so socially accepted to have a somatic, meaning body injury, that strangers will sign

their name on your injury, directly on your injury.

Isn't that a weird thing about, and this just happened in front of my eyes and I thought,

that is really interesting about human beings and what kind of things we will support and

the fact that we put our names, it wasn't just little sayings like, hey Billy, hang

in there.

It's Dr. Jim McKenzie right on the injury and that's something that's never left me.

So for those of you who are up for a challenge, treat pain where nobody's going to pat you

on the back.

So at the end of my day, if I come home, if I ride my elevator in my condo building and

there's the financial guys, I get off first, the financial people, they go up to the penthouse

and if someone says, hey, what'd you do today?

I say, well, I'm a psychiatrist.

People make that awkward, whoa, I better be careful what I say, and it's funny and all

that, but is it?

Or is that a reflection of stigma?

Is that because it makes people feel uncomfortable?

So it's just something, it just is, but it's a really neat challenge, but psychiatrists

don't go into this job, DOs in general don't go into medicine because we're looking for

people.

We're trying to get our high school guidance counselor to say, wow, I remember Jim, because

they don't know what a DO is.

So becoming an DO, you self-select out all those people that need to have an MD to feel

good about themselves, that you need your mom to say, my kid's an MD, right?

People don't know, that's why you're making this podcast, people aren't inherently aware

of it.

Psychiatrists, in addition to that, we don't do our jobs because we're looking for people

to say, oh wow, good for you, that's pretty cool.

People hate our patients.

That was a really bold statement I just made, right?

I mean, there's stigma and people say, Jim, why, or Dr. McKenzie, they'll say, why is

it that patients in psychiatry are misunderstood?

And I say, they're not misunderstood, they're hated.

There is blind hatred against people from a mental illness.

Why is that?

It's the personal issue of the person that's spewing the hate, like with everything else

that we see in society, right?

People hate the things that they're scared of.

And so, you know, we have a lot of work left to do.

I did want to say too, psychiatry is very different from like traditional medicine,

like when you think surgery or internal medicine or something like that.

And in that, like your primary goal is to really talk and get to know this person and

understand their pain or understand, you know, what's driving them to act this way or feel

this way.

And I just wanted to know, was that like a big component of psychiatry that kind of drew

you towards that career?

I tell you what, you have no idea how interesting the timing of that question in this, this

interview.

And again, so I graduated from the DO school in 01, became an adult psychiatrist, 04 I

graduated at Loyola.

By the way, Loyola University Medical Center, a third of the internal medicine residents

were DOs.

It was really cool.

So, yeah, it's really, really neat.

You know, you move to a new city, you go to a new hospital, and then you're in your orientation.

And you know, what normally happens is people that you kind of look friendly, you sit by

them.

You're picking up your ID badges, and you see the DOs, well, we're like a natural little

family within a family.

And I found the MD, were wonderful people to be around, they're awesome.

But if you bump into another DO, and you're in an MD hospital, you can't help but be a

little bit friendly with each other.

Hey, where'd you train?

Oh, I was at the, it's kind of cool, it's an extra thing.

But at Loyola University Medical Center on the west side of Chicago in Maywood, very,

very friendly DO institution.

I've never found an institution that's not DO friendly, but I found some places that

are exceptionally friendly towards DOs.

And that's one of them.

But I digress.

So then I went into Northwestern University, the Children's Hospital.

It was Children's Memorial, and then the Lurys donated wonderful amounts of money to that

hospital.

And they changed the name to the Lurie Children's Hospital.

But then I graduated in 2006.

And that was your Child Psychiatry Fellowship, correct?

And that was my Child Psychiatry Fellowship, yeah.

And you asked me a great question.

And then I just took a hard left and told you about the dates that I graduated.

But the reason I did that is I wanted to point something out that I realized about myself.

So if I can have the one year wiggle room here, I can say 20 years ago, I graduated

med school, right?

So it's not quite, but give me that year because it sounds better.

So I've been doing this for 20 years.

It's taken me 20 years to be able to say what I tell you next.

It's so obvious, I've never thought of it.

So what I'm doing mostly right now is I'm working on teaching primary care physicians

how to do the basics of psychiatry.

So this is on my mind all the time because for me as a child psychiatrist, I'm trying

to get family medicine doctors and pediatricians interested.

But to do that, you have to help people grapple with that feeling of discomfort in psychiatry.

So what I've learned to do is I don't make any excuses for psychiatry.

I put the spotlight right on what you just so wisely said.

Because by the way, when I was a third year med student, that thought that you asked me,

your question wouldn't have even occurred to me.

I would have thought, yeah, it's a little different just because you're not doing procedures

and there's no scopes and there's no x-rays.

But beyond that, there's a fundamental profound difference.

You ready for this?

I don't have anything that I treat, anything that has a known etiology on a molecular level.

Think about that.

I've only started to say that recently after 20 years out of med school.

And I say to very smart people around me just because I'm not even sure if I'm right.

That's what I think.

I can't think of anything that has an absolute molecular level.

I mean, think about endocrinology, hey, what causes diabetes?

We know what causes diabetes.

We know how insulin works.

We understand the mechanisms of it right down to the biomechanical levels of how this works.

What causes depression?

We don't know.

We have theories, but we don't know.

And a very smart person would say to me, yeah, but Jim, you just got done talking about those

serotonin antidepressants.

So if you increase serotonin, I say, right, but that's not the cause.

We can increase serotonin.

We know people feel a little better, but don't confuse the treatment with the cause.

Just because increasing serotonin helps people to feel less anxious and depressed, it doesn't

mean that the cause was low serotonin to begin with, right?

Now in med school, they teach you to keep it simple.

They just say low serotonin depression.

But the fact of the matter is that we know more serotonin helps you to feel less depressed,

but we're not certain that was the cause of depression to begin with.

A little better is the dopamine hypothesis.

So for those folks that suffer from schizophrenia, who, by the way, are the most amazingly kind,

misunderstood people you've ever met in your life.

These are the most wonderfully kind people, and the movies just do them a terrible disservice.

And sure, they have hallucinations, but a lot of them know that it's a hallucination.

And I had people with schizophrenia that worked full time and drove a semi.

They're not like what you think on TV.

And by the way, hallucinations don't necessarily have to be terrible insults from a devilish

voice.

It could be your grandmother who is saying very sweet things to you.

You know, it's a very complicated thing in itself.

But even schizophrenia, we have the dopamine hypothesis, which are the antipsychotics with

lower dopamine.

But that's not for certain that that's not the pure cause, because I can take away hallucinations,

but I can't take away those social impairments, someone with schizophrenia.

So there's more to it.

And I'm just picking on those two, depression and schizophrenia, just as examples.

We don't know what causes those, so we do the best we can to treat it.

But without a known cause, I don't aim for a total cure.

Now, autism, one in 54 kids.

I see kids with autism.

In my heart, I don't think autism is a psychiatric disorder.

It feels different than the kid that I saw right before this patient.

The kid that had depression and panic attacks and now had a breakup in high school.

There's an emotional component mixed with a chemical component.

The kid with autism comes in, that doesn't feel like emotion.

I mean, there's an emotional component on the surface level, but it feels much deeper

than that to me.

So at some point in our lifetimes, we're going to know exactly what causes it.

Be it chemical, genetic, whatever it is.

The day we know what causes it, this is the other thing about psychiatry.

When we do have a biochemical molecular level etiology, the day that's discovered, I say

goodbye to my patients because psychiatry is reserved for all of the disorders that

we have yet to find a very, very clear specific cause for.

And as they are discovered, as they will be, I wave goodbye.

That's an interesting part of psychiatry as well.

So you're working with pain for people that are disliked and you don't have a cure.

So I used to be a hospital psychiatrist for a lot of my career at the Children's Hospital.

So if I had two people in two different rooms, so in room one, I have someone hallucinating

and we think it's because of an emotional problem.

And in room two, I have someone doing the exact same hallucinations, but we know it's

because of a brain tumor, the way society and even healthcare workers approach those

two kids is a completely different way people walk and talk around those two different types

of patients.

Right?

I think it's fear because these aren't bad people, you know, oh my goodness, I have screwed

this up myself, you know, so I'm not about this by any stretch of the imagination.

But psychiatry, to answer your question quickly, which I'm sure you would have preferred, I

would have said psychiatry is the to-do list of healthcare.

It's the to-do list.

The problem is things like COVID come along and right now there's people really, really

smart, wonderful men and women working in labs working on what causes autism right now.

But it's a pandemic.

So anyhow, it's our to-do list and we need people more than ever to do this.

And that's such an interesting way to think about psychiatry.

I guess I've never really thought about it as a to-do list, but you're absolutely right.

It took me 20 years to be able to say that.

And I've just been saying it now because at this point in my life, I'm now trying to teach

non-psychiatry physicians how to do the basics.

And when you're in a room full of people, and maybe you saw this in my eyes when I talked

to you when you were earlier in your medical training, I won't lie.

I'm trying to get you guys to think about maybe I should be a psychiatrist, but there's

that little dark feeling that everybody has in their stomach.

And it's this feeling of, but I don't know what to do.

And what I'm trying to do is let people know, neither do I.

This stuff doesn't have a cause yet.

So if I picked you up in a helicopter and dropped you into a city that you've never

been in before, you don't know where the grocery store is.

So you should feel lost.

And so there is a component of that.

But I've never ever heard anybody ever just flat out say that before.

And I'm trying to do it, not to put down psychiatry.

I'm not trying to give like some exposition.

It's just a real challenging field, and without known ideologies, of course it would feel

different.

You know?

So.

That was a very fascinating answer.

I do want to follow your career path.

So you'd mentioned you did your residency at Loyola, followed by a fellowship at Lurie

Children's, which is a Northwestern Children's Hospital.

So after fellowship, how did you go about finding a job and what made you kind of go

with the hospital or the location that you ended up with?

That's a great question.

I want people to know if you're thinking about psychiatry, you're going to hear stories from

people my age and older.

I'm 49.

So me and up, you're going to hear stories of, oh my God, they have the oral board exams.

Okay, they're gone.

They don't do them anymore.

They no longer exist because they were, wow, I mean, I have never been that nervous in

my entire life, like tears of anxiety, fly to a different city, stay in a hotel.

We had to interview a real patient for 30 minutes.

Nobody interviews a new patient for 30 minutes.

Are you kidding?

And it's a past field exam.

And then after the 30 minutes, you got grilled in oral examination by two people.

It's gone for psychiatry.

Other specialties still have it.

We don't.

And I have a horror story.

Oh my God, it is a really, really interesting thing.

And you did it for your adult and then for child psychiatrists.

We had to do it again for child psychiatrists, anyhow, and they don't do that anymore.

But that ties into my story.

So I was graduating from the Northwestern Child Psychiatry Fellowship.

And in 2006, when I was finishing, we'll then be game.

Now keep in mind, I'm already done with the complex one, two, three.

Now I'm doing psychiatry and psychiatry, the American Board of Psychiatry and Neurology,

they don't care if you're a DO or an MD, you're a psychiatrist, man, you're all in.

We all take the same board exams.

That's why as you get further and further away from DO school, you realize nobody cares.

And of course, I'm aware of the really neat merger now, but the level of the ACGME.

And you'll know more about that than I do right now.

I'm a little bit far from it, but I know it's becoming less and less of a separation.

And as those of you who know the DO history, there has been a couple of times in the history

of a DO where the United States has offered to us, hey, DOs, knock it off.

Just mail in your certificate and we'll make you MDs.

It's been offered to us before.

And we proudly say, not in your life, we like what we are.

So never make an apology for that, for being a DO.

And if this was a video presentation, which I'm glad it's not, because I'm definitely

in need of a COVID haircut, I would take my camera, I would point it out my window, and

I would show you the statue of the first DO that just ironically is in this neighborhood.

And remember, the first DO was an MD, right, Andrew Still, MD became a DO.

So I graduated and I still had to take a series of four board exams.

This is after your fellowship, correct?

Correct.

So I stayed where I trained because I was done now with all my training, but now I had

to take these ungodly, terrifying board exams.

And I wanted to be around people that I knew and I wanted to stick around academics.

So initially I thought, well, let me stay around these extremely smart people.

And you know, what better way to prepare for oral board exams than to surround myself with

a faculty that I just was trained and stick around.

These were the top people around for my profession, the folks that I wanted to be around.

And I had this wonderful, he's still my mentor, but he's now in Utah.

I had a wonderful mentor, Rich Martini, which is a great name, isn't it?

Rich Martini and child psychiatrist, wife's pediatrician, Sue.

She was here in the Chicago area and they're both at Primary Children's in Salt Lake City.

Rich was my mentor and when he left, I stumbled into his job and did it terribly as compared

to him.

But that's then how I ended up staying where I trained.

And now if you were a resident and you were asking, hey, what do you think about staying

where you train?

I would say think twice because now I'm no longer a medical student.

I'm not a resident.

I'm not a fellow.

But if you work where you trained, you never are quite anything but a trainee to some degree.

You know what I mean?

Everybody that knows you knew you from when you were a resident.

So if I was in a group, a meeting with five or six other doctors, it would be Dr. Smith,

Dr. White, Dr. Brown, Dr. Bill, and Jim.

But that's a little minor thing.

I've thought about that before because what if you train at the best place around and

then as an attending, you want to work at the best place around?

Well, there you have it.

And did you stay in this position or at least in academic medicine for quite some time?

Yeah.

So now I graduated in 06, but I joined staff.

So I'd already been there for a couple of years.

And I stayed there another about 10 more years.

And I had the coolest job in the world for young people.

I covered the 50-bed children's hospital emergency room as a psychiatrist.

Just in that position, can you just tell us what your day-to-day look like?

Because that sounds really exciting.

Yeah.

So you cover the ER, then you cover the hospital, the medical floors.

So make a long story short, 22-floor hospital, I covered the entire thing except for the

psychiatry floor.

So cancer kid hallucinates, I go see him and do a full consult, figure out why you're hallucinating,

right?

Someone comes to the ER, the overdose, I run down to the ER and do that.

And I had a team of physicians and PhDs.

We worked hand-in-hand together and had a blast.

It's just a young person's job.

I mean, I got shingles.

I'm not gonna lie.

We didn't know what burnout was back then, but now looking back on it, I was wiped.

One thing I did definitely wrong in my life is I'm sitting in this condo that's right

next to Northwestern still.

And I thought as a young doctor that, hey, you know what would be really smart?

I'm gonna get a little apartment across the street from where I work.

That way I can sleep in an extra 20 minutes a day.

Dumb move.

Dumb move.

The people that figured this out lived 45 miles away.

Everybody likes commuting.

And yeah, sure, I saved X amount of money on gas and a car, but I didn't get that.

What do they call that?

If you're in a submarine and you go through the airlock, right?

When you leave the submarine, I don't even know if you do that.

That's ridiculous.

But I lived so close to where I worked that I could probably be in a different podcast

called How to Become Burned Out, because I would leave the ER and we'd saw 1,500 kids

a year.

That's a lot.

And challenging, challenging job, and I used to plug in my headphones and listen to music,

but I would be home before the guitar solo.

You know?

So yeah, it was a dumb move.

So don't do that, folks.

Give yourself a commute.

I help a community center right now.

Of course, we're all working remotely with COVID, but I'm having a fun time now helping

a couple of days a week, a community Medicaid mental health center.

And it's lovely, but I ride the train for...

It takes me about an hour to get up there with the training and the walk, the greatest

thing ever.

That's what you need.

You need to put 45 minutes of life in between your work.

So while you were at the hospital, what did your...like starting from when you woke up

to when you left, not including the commute, what did your day look like?

This is an interesting thought.

Anybody that says...and I met people that say this, I would like to be a psychiatrist,

but I enjoyed internal medicine.

I would like to be a psychiatrist, but I really enjoyed learning about rheumatology.

So what you do with that, again, there's more than one street to get to the same place.

I was a hospital psychiatrist.

So those are called consult psychiatrists.

So my day would be, I would get up, go to morning rounds at 830 in the morning, and

then the pagers would start exploding and we get consults.

Every single day was different than the day before.

These are emergencies.

Hey, a kid, four years old, just ran for their life, and they were trying to find him there.

There's hiding behind the MRI machine.

My research interest was organic, again, that just means chemical.

Only chemical causes of hallucinations.

That's what I found to be fascinating.

So in a nutshell, if somebody is hallucinating and standing in front of me and I'm called

to see that person, my brain as a medical doctor, as a DO, right now, if you told me

I'm hearing a voice of somebody, my first thought is not mental health.

My first thought is, oh, let's see if you have an infection in your brain or metabolic,

endocrine, neurologic, infectious, neoplastic, vascular, pharmacologic, not psych, pharmacologic.

Did you have too much anticholinergic, did you have too much allergy pills or did you

use drugs?

So my job that I would do was to meet people hallucinating and try to work with the medical

staff to figure out, hey, what's the chemical cause of this?

Because the beauty of that is, once you figure out what it is, you can fix it.

And now if we go back to what we were talking about originally, how psychiatry doesn't

have any known etiologies or cures, I found a way to hack that.

I worked on a hospital floor and those of you who have done your hospital rotations

and you're working in an ICU, we know what happens at night.

The people have what's called sundowning and that's a cute word for delirium or neurologists

call it encephalopathy or whatever.

It's a really confusing thing, by the way, because whichever subspecialty walks in, they

have a different term for it.

But it's something organic chemical happening to folks in a hospital and they hallucinate

and act out and they get agitated.

Happens to one out of three people in an ICU in adult hospitals and children's hospitals.

That's a huge number.

One third of your patients will kind of have mental status problems at night.

It's so common that people become comfortable with it and that's not good.

But that's what I used to do.

So for those of you who are on the fence, gosh, I like psychiatry, but why do all that

medical training and then not use it?

Which by the way is BS.

Can I tell you a true clinical story that's happening right now in my life?

I have a wonderful high school kid that goes to a local school who carries the diagnosis

of schizophrenia.

This is a true honest to God story and I met her a few months ago and you can tell quickly

this kid does not have schizophrenia.

Very socially relatable, great grades in different school clubs and all this stuff but carries

the diagnosis.

One of the things that has been psychiatrically hospitalized for schizophrenia is taking psychotic

medicines.

I get to know this kid and the family is like, well, why are you working at this community

center?

And I explained my life so far of what I've done and it's just a side gig.

I use it to buy groceries right now while I've been working on some legislative stuff.

And they said, what did you usually do at the hospital?

I said, my favorite thing is to find out why do people hallucinate from a chemical cause

and fix it so they stop hallucinating.

And they said, well, our daughter and this girl told me the story that she's diagnosed

with schizophrenia because she got really embarrassed to tell me this.

She says, listen, I know this can't possibly be true but I believed, past tense, but you

could tell she still believes it.

There's people that live in my walls.

And I thought, what?

And she says, I know, you think I'm nuts and that doesn't make any sense because how could

someone live in your wall and we've had people look and the last time I talked about this,

I ended up getting locked up so please don't lock me up.

I'm not trying to talk to them anymore, blah, blah, blah.

I said, well, wait a minute, there's nothing about you that fits with like a psychotic

disorder other than you just described to me.

And so I said, tell me more.

She says, well, and she described it to me and it's been happening to her off and on

over, you know, three, four, four, five years.

And what we discovered in talking was it only happens to her at night, it exclusively happens

to her when she's in bed.

She never ever has experienced any type of a hallucination and now she wasn't sure they're

hallucinations because it's real, you know.

And to make a long story short, even though it's far too long already, what was happening

to her is she was having sleep paralysis, she was dreaming and her eyes were open, right?

And you learn about these things in medical training in your residency, right?

So in medical students later, whether you're on medicine or if you're on neurology, if

you're in psychiatry, you learn about hypnopopnic hallucinations, you learn of sleep disorders

that are associated with hallucinations.

And this young lady was having that classic symptoms, but she had never talked to a psychiatrist

before.

Well, she had been in a hospital once, a short stay for three days where she was brought

in and they went away because she probably didn't have that happen.

That to me is the fun of being a psychiatrist.

Now, I've gotten to know her the last six months, she's off all of her meds, I'm just

keeping an eye on her before we completely undo her diagnosis and I can say, see you.

You know, so you get to do that as a psychiatrist, so if anybody likes the concept of psychiatry

but you say, well, I'm a psychiatrist, not a psychologist, why did I do all the premeds

stuff?

Because you want to see emotional symptoms and then think like a medical doctor to undo

them.

And what I had to do in the hospital was, hey, go see Billy in room three, he's hallucinating,

can you put him in psych?

And I go up and see the kid in room three and say, hey, that kid's liver enzymes are

triple normal, you know, there's a chance the kid's having hepatic encephalopathy, give

me an EEG, let's look for slowing and triophasic weight.

And oh, yeah, you're right, that is happening.

How did you know that was schizophrenia?

I didn't know it was schizophrenia.

I just thought it, statistically being that one in 40,000 kids have schizophrenia, every

single kid here, the third of them that hallucinate at night probably isn't one in 40,000, you

know what I mean?

Yeah, so sometimes psychiatry symptoms, people need to remember there's organic causes to

them.

It's a lonely world sometimes, you know, and I've published a few, if you Googled me and

you look up, I don't have a lot, maybe six, seven little case studies, little things like

that, but each one of those has been so profound, always been a chemical cause of psychosis.

So you have to keep your wits when you're looking at a patient hallucinating and a kid

hallucinating brings a lot of emotions to the people looking.

People have asked me, what's the most bizarre case you've ever been in your entire life?

And I say, oh, it was the time my grandmother did an exorcism in the emergency room.

That was the most bizarre thing I've ever seen in my entire life.

And it was the most psychotic patient I've ever met in my entire life.

And we discovered that kid had absolutely nothing wrong emotionally.

And we found out someone had stopped the muscle relaxant the kid took for cerebral palsy and

now did I know at the top of my head that stopping a muscle relaxant quickly causes

severe psychosis?

I probably learned it somewhere in DO school.

Among all the other information that you have to know, it gets buried, yeah.

You nailed it, right?

But the reason you're in med school is that you know how to look stuff up later and you

know when to switch categories.

When you start to realize, wait, that doesn't, what else could this be?

That's the key to being a physician.

And it doesn't matter if you're a psychiatrist or an OB or an ER.

We all think the same when it comes right down to it.

All right, switching gears again a little bit, you briefly mentioned that you're involved

in some legislative stuff.

Can you tell our listeners more about that?

I would love to.

So assuming that I can't get your listeners to become child psychiatrists by tomorrow,

but because I can't reach through the podcast and grab high school students, college students,

DO students, we need psychiatrists like nothing.

You have no idea.

We need you so bad to come work with me.

Two psychiatrists could set up an office next to each other, be complete competitors, and

you wouldn't make a dent.

And that's for the pandemic.

This is gonna be wild.

So just to put it in perspective, I used to be the head of the psychiatrist in Illinois

at a political group.

And I think if I think back, that was 2014, I think we had a couple thousand members.

This was general psychiatrists.

It's funny, I'm a child psychiatrist, so I call general psychiatrist adult psychiatrist.

That's not fair.

A general psychiatrist can treat kids too.

I just think I'm snooty, patooty, and I'm all that because I did a second residency

called the fellowship to get an additional board certification for child.

That doesn't mean that only child psychiatrists can see kids.

General psychiatrists can do that as well.

That's like saying, oh, you're a family medicine doctor, you can't deliver a baby.

That's not true.

They absolutely can, and they're really, really good at it.

Again, look at how much overlap there is in psychiatry.

But the fact of the matter is there's about 250 child psychiatrists in Illinois, 250 child

psychiatrists in Illinois.

Chicago, third biggest city in the country, there's about 50.

Now there's not 50 of anything in a big, I mean, a big city like this, there's, I should

look this up so that I have this number for future interviews.

I know there's more than 50 Starbucks in Chicago, you know what I mean?

We need to have as many psychiatrists as there are Starbucks, right?

So there shouldn't be 50 child psychiatrists in Chicago, and I'm one of them.

So when I used to cover the ER, it was kind of me, and people were coming to me from Michigan

and Indiana and all these different public schools.

If you say the word suicide or death, it's like saying bomb in an airport, and you can't

go back into school without a letter from a psychiatrist.

So back to one of your earlier question, what was your day like?

Well, my day was a mixture of the most fascinating, interesting cases and severe psychosis and

then complete misunderstandings.

I once had to write it, oh my God, but it was usually silly stuff mixed with the most

bizarre stuff you've ever heard, you know?

And some of the most bizarre stuff you ever heard had completely plausible explanations.

I once met someone that was in the witness protection program, but when they said they

were in the witness protection program, the person that heard that assumed they're psychotic,

but they really were in the witness protection program, you know, those kind of things.

So it's kind of a fascinating thing.

But what I want people to know is what I've been doing since working in the ER as a child

psychiatrist is I'm turning to my colleagues that also work with kids and say, hey, pediatricians,

there's only 50 of me in Chicago, and there's 250 of child psychiatrists in Illinois.

I know you don't do a whole lot of psychiatry, but there's 2,000 of you, and hey, Illinois

Academy of Family Medicine, I know you don't do a ton of psychiatry.

They do some, and they're really, really good at it, by the way.

Family medicine doctors are amazing, and again, DOs, there's a family medicine focus.

We embrace that.

Family medicine doctors are incredibly good because they know people in their good times

and bad times.

I only meet people when you're having a rough time.

Nobody calls the psychiatrist, hey, I'm feeling good, I'd like to come in and talk to you

about it.

How much do you charge?

You know, that doesn't happen.

But a family medicine doctor sees people back to school physicals, and you get cleared before

you travel, and you get your flu shot, you know, you get to know people.

What I've been doing with my life in the last couple of years is, and Illinois, for those

of you listening that are in Illinois, you should be extremely proud.

I didn't create the law, but I helped to pass the law.

I testified at the Senate and at the House, and the governor signed it and it went into

the law last January 2020, and it was just getting ready to start in this pandemic hit.

But Illinois is the first state in the country to have a state law, it's a law, it's signed,

it's a law that requires private insurance companies and public payers to reimburse primary

care doctors to work with the psychiatrist so that they keep their own patients stigma

free.

So another way of saying that is, you're depressed, and you're my age, you don't necessarily want

to go see a psychiatrist, but you've got a family medicine doctor that you really like,

you can get your care from that family medicine doctor.

And then what would happen is the state law makes it so that patients can go to one doctor

not two, and then behind the scenes that family doctor maybe once a month keeps a list and

runs those cases formally with the psychiatrist and they go over each case.

Now we're not asking primary care doctors to take on schizophrenia and autism, and you

know, I'm not trying to make psychiatrists out of people.

I'm asking them to do the low acuity, the cases that they would do if they have somebody

to talk about.

Right?

And it sounds so obvious, and you would think, why don't people just do that?

But we had to get the law to do it.

So I left academics, I went to Rush to work on this and help Rush set this up, and I had

a really, really good time, but then the American Psychiatric Association said, hey, you know

what you could do?

You could pass a state law rather than one hospital do it.

So back to my original job at Lurie's, the Pritzker Foundation gave a very wonderful

gift to Lurie's, $15 million to do what I just described.

Here's private money, boom, you do that, set that up so kids can get mental health care

at their pediatricians.

Wonderful.

Thank you for that gift.

Now you'd have to continuously give gifts to keep that going.

Now a state law has now kicked in.

So that was one of the reasons I sadly, because I've had a blast in academics, and I realized

if you want to do kind of political advocacy stuff, you can do it at one hospital, or you

can make a change for every single person in the state.

And that's what I've been doing the last few years.

How did that get started?

Who did you have to talk to, or did you just wake up one day, make some calls?

I took an Uber and I just went to the Capitol and said, no, I would love to lie to you.

And the only problem is I can't lie to you is that you might have a listener in Washington

State right now.

You probably do, right?

So anybody who's from the West Coast area in Seattle, University of Washington came

up with this 20 years ago, and they should be extremely proud.

It's called the Aims Center, A-I-M-S, it's absolutely worth your time to look this up.

It was their idea, they've been doing this for a long time.

And I was trying to teach pediatricians on my own.

I started to do this as a garage project without realizing it has a name.

I was thinking, geez, somebody should teach pediatricians the basics of psychiatry.

And then I was doing it with the Northwestern residents, and they liked it because it helped

prepare them for their pediatric board exams that had some psychiatry.

And Rush called me and said, hey, you dummy, what you're doing has a name.

It comes out of the University of Washington.

Come here, do it, we'll call your job title that, and we'll make this happen.

So I did it at Rush for a couple years, got it set up, and I loved it.

And then the American Psychiatric Association said, hey, if you really want to do this,

pass a law and let every single primary care doctor in the state of Illinois participate

rather than one hospital.

And I want to be careful.

I want to point out, it's not that I didn't like being at Rush.

I loved it.

In fact, if you think about it, they were extremely progressive, and they're way ahead

of everybody else, and Lurie's way, way ahead of everybody.

So I said, wait, rather than one or two hospitals do this, let's make this so out in a rural

nowhere land where there's no psychiatrists at all, you can go to your family doctor.

Yeah.

Now, in the state law, if you look this thing over with a microscope, there's nothing in

it about psychiatrists being paid.

And that's the key to this whole thing.

It's all about reimbursing primary care doctors to participate in a model that helps them.

Yeah.

Well, that's pretty powerful, especially now that you're almost bumping up the number of

psychiatric providers.

Well, can I tell you something I'm really, really, really, really, really proud of?

Yeah.

Are you aware of Advocate?

Have you heard of the Advocate system?

Yes.

It's a big system, Lutheran General.

Yeah, it really is.

So you nailed it.

Advocate Children's Hospital, which consists of the pediatricians at Lutheran General and

at Christ Hospital, they have a DO.

Every time we say DO, like there should be a sound effect.

They have a DO, Frank Belmonte, who is a pediatrician, who's married to a psychiatrist, who trained

with my classmate, who's a DO, who's the department head of the Christ Advocate, Christ Psychiatry.

Frank Belmonte, the pediatrician said, hey, Jim, tell me about your model.

What are you trying to do?

And I said, well, ultimately, I hope I get about 12 pediatricians and we can set this

up and I'm going to try to do this collaborative model.

And Frank said, well, would you do it with Advocate and North Shore?

And here we go.

And so I think this can actually work.

People are wanting to do this and this pandemic, which has been the most terrible, miserable

thing for everybody, is also jumping ahead things like telemedicine and collaboration

in light years.

So there are really wonderful organizations that believe in this.

The reason I interrupted you to tell you what I'm so proud of is I've been working on this

for three years.

I'm teaching pediatricians right now.

Earlier this week, I did my fourth class.

So I'm doing it.

We're actually, actually doing it right now.

And I have to send a shout out to the Advocate system because they believe in this.

And my heart is also with the kids in Illinois, especially here in Chicago, South and West

Side that are Medicaid eligible.

And I've talked to the folks in the Cook County system.

Maybe we'll be able to help them out too, because they might have two, maybe one child

psychiatrist in their entire system.

I could be wrong, though.

I'm not 100% sure.

Think back to Lurie Children's Hospital.

They have about a dozen child psychiatrists.

So there's places that don't have any.

So now that you're pursuing this more legislative stuff and I understand that you're still doing

some clinical things with that community clinic, what would you say are the big pros and cons

of stepping away from academic medicine to pursue this political side?

So when you someday say to me, Dr. McKenzie, do you remember when I met you October 22nd,

2020, we did the podcast, and I'll say, yeah, I absolutely do.

You're going to say, hey, could you write me a letter of recommendation?

I've decided that I'm going to become a neurologist at the, I want to go to New York City and

I need a recommendation.

And I would say, badly, I absolutely would.

My letterhead now says Jim McKenzie, psychiatrist.

When I worked for Northwestern, it said medical director, assistant professor, Northwestern

University, blah, blah, blah, blah.

It's got all that stuff, titles, and you know, a million, I mean, things like a paragraph

and titles, you know.

So one of the things that's nice about academic medicine is you're all that, you know, you've

got all this stuff and you're publishing and you're doing all that.

Now, I admire that, I think that's really cool, and the people that do that are brilliant

and they're saving all of us, you know, and you have to do it.

Sometimes though, in any big organization, it's sometimes very large institutions don't

make fast pivots, like imagine like a great big oil tanker out in the middle of the ocean

and the thing's this giant, massive long ship, and if it needs to make a fast left turn,

it takes it about five miles by time the whole thing moves over, right?

Some of these huge organizations that have the smartest people you've ever met, something

like what I just described, this model, that's a tricky thing to ask a very established center

to do.

Now, they'll do it and they are doing it but it's just a little bit easier if you go rogue

like I'm doing.

So right now, I left a career with, you know, full-time academic psychiatrist and yeah,

I mean, I assembled a few little projects just to be able to pay for groceries and I

can't do this forever, you know, I'm running out of money, you know, but I'm piecemealing

things together and you do a little teaching.

I opened a little private practice just to see what that was like and that was fun.

It's just that I think that there's so few child psychiatrists.

See, some people say, Jim, there's so few child psychiatrists, how can you not have

your office open?

And I said, well, in one day, I can go to work and see 8, 10 kids, you know, in a day

or in one day, I can talk to 8 to 10 pediatricians who each talk to me about 10 of their kids.

There you have it.

This is all about population-based.

So I don't ever want to completely stop seeing kids.

One of the neat things about working for a non-profit Medicaid clinic is, oh my gosh,

why didn't I learn Spanish, by the way?

Oh, I agree.

I agree completely.

Young and smart and healthy and you can still learn, I have to use an interpreter for half

my day, but I think if you're going to teach for me as a psychiatrist, a child psychiatrist

to teach pediatricians and family medicine doctors how to do the basics, I couldn't look

them in the face without being able to say, yes, I still do it too.

But I'm trying to build a new way of thinking and it's really, really tricky.

It's really, really tricky.

But you know, again, one of my challenges is I'm trying to find elementary school kids

that are thinking about being doctors because I mentioned this to you before we started

on the podcast.

For me, as someone that believes in the emotional health of kids and I believe in doctors and

pre-med students and high school kids that enjoyed their science, other kids tell you

you're a nerd, well, guess what?

You're going to cure something someday.

Keep on with your science or projects.

I believe in you and I've got to find a way to get young people that like working with

children to not become pediatricians.

And what people like is working with kids and you like the medical aspects of it.

Become a child psychiatrist like I did.

Get this, try to be precise.

One out of three kids that's seen in an outpatient psychiatry clinic has a food allergy.

Think about that.

And if you go to an allergy clinic and you say, hey, of your patients that come here

to this allergy clinic, how many of them are seen in psychiatry for anxiety and ADHD?

It's going to be a very sizable number, maybe not quite one third.

Think about that.

There's so much overlap between stuff.

Isn't that interesting?

So I say to those listening that, gosh, you know, I really want to go into healthcare

and I want to help people and I say this, you want to help people do the thing that

stigmatized, help people do the hard thing and if you fear, well, I don't want to work

in psychiatry because they don't have a cure yet, embrace that.

Come on in.

Let's do this.

This is biochemistry.

Are you kidding me right now?

Everything's got a biochemical cause.

We just don't know what this is.

It's the pasture is, it's fertile.

You can pick anything in mental health and try to figure out what's causing it.

Do you feel like your background in psychiatry and maybe even as a DO, do you think that

that's kind of helped you with this legislative side and being able to pass these laws and

getting primary care physicians on board with what you're trying to carry out?

Yeah, that's a very good question.

Working in political realm, it's a little bit shocking to see there's that old saying

when you see how the sausage is made.

Everybody as a medical student and for you high school students and college students,

you'll do this when you become med students if I don't scare you out of the profession.

When you become a medical student, whatever you're thinking about doing, you can join

their national organization as a student and usually you get a free membership and the

monthly journals will start coming and everything.

So just to make this up, if somebody wants to be a psychiatrist, you can already join

as a medical student, the American Academy of Child and Adolescent Psychiatry.

You join for free and boom, and you're going to be connected.

You'll be invited to our national conventions and stuff.

Oh God, it's just the mechanisms that go into place with the political world.

When I was younger, I would belong to those organizations and I thought, okay, the way

that you do this to affect change advocacy is to go once a year and meet the legislators

and you go and you wear your white coat and you go to the Capitol and that's great and

you should absolutely do it.

But put yourself in the shoes of the state representative or the senator that's at work

that day.

They're human beings.

They went to work, they spilled their coffee on their shoe and they're doing the same stuff

that the rest of us do and all of a sudden you look up and here comes 75 psychiatrists

marching towards your office and you're like, oh dear God, what do they want?

That's really, really important.

You got to do it.

You absolutely have to do it.

You really want to make change because to make change, and I'm just thinking of Illinois

for a second, but this is to every state and nationally too, right?

There's two ways you can make change.

You can do it with legislation, right?

You can just change a law or there's usually an educational route to do something.

You can get more training and make this happen and it takes longer and that's often the safest

and the best ways to do it.

Or there could be a law that's just changed.

There's more than one way for things to happen in this world.

Is the long, hard, traditional way or there's real fast laws that can just change?

And I'm not trying to pick on any topic in particular, but just jumped into my mind was

like marijuana.

Medical groups were saying, no, no, no, no, no, careful with that because kids are going

to get marijuana and it's not necessarily as safe as it might seem.

But the laws were made and boom, it's legal, right, in Illinois.

And then the people that make laws may or may not have biomedical training, probably

not.

But someone without medical training pass a law that can have greater effect on healthcare

than a physician.

That was a whole circle way of me telling you be involved.

But what I found is legislators would much rather get to know you on a one-to-one level.

So for me as a psychiatrist, what I found is interesting is everybody wants to share

stories with a psychiatrist and everybody wants to know what you think about their cousin.

And there's, oh my gosh, do I get asked about presidential stuff?

I get asked all the time.

I get asked every time I'm at an event.

I can't even tell you the people that ask me, you would know and be shocked.

Like people ask me about all the different candidates and they really truly want to know.

And of course, I can't really answer the question because I've never met anybody.

I've never met President Obama, I couldn't tell you what he's like.

I've never met Trump, I can't tell you what he's like.

I see how they act on television, but I believe that that's people acting and portraying a

role.

So I really, really don't know.

There's no way that a radiologist couldn't, you can't ask a radiologist, hey, what do

you think about President Obama's x-ray?

You're like, what?

I've never seen President Obama, I have no idea.

But everybody would like to get to know a psychiatrist.

And if you take the time to get to know the lawmakers on a one-to-one, go have breakfast

with them, get to know them, don't ask them for anything.

Just get to know them, offer to help them with issues.

And that's just what I found has become more helpful for me with my own legislative work

as a DO and as a psychiatrist is offering to listen.

Everybody asks your state rep and senators for things.

I need this, I need that.

You need to vote for this, you need to vote for that.

Nobody ever says, hey, how can I help you?

There's a wonderful, wonderful state representative in Northbrook, Illinois named Jonathan Carroll.

He was gonna run for local school board and he ended up being a state representative and

he told me a great story once.

He's not someone that thought, hey, I'm gonna go into politics.

And he's a wonderful state rep.

Well, before the pandemic, it was on a lot of the local news that there was a movement

to get rid of all of those restraint rooms inside the schools.

It's hard to think back to before the pandemic now, but it was a hot topic that was going

on.

And Jonathan Carroll, state representative Jonathan Carroll was on the local news saying,

look, you gotta get rid of those rooms.

And he was so brave.

He said, when I was a kid, I was put in those rooms and it traumatized me to this day.

I reached out to him and met him and wanted to sit down and talk to him and say, hey,

you want help with your...

It was his idea.

It wasn't a psychiatrist.

He took the initiative.

I was able to call him and say, hey, do you want a couple hundred psychiatrists to help

you with this?

Oh, by the way, state representative Jonathan Carroll, I can't help but notice you also

have a bill to get EpiPens put on the public aid formulary for underserved kids that have

food allergies.

And so, hey, as a physician, can I help you with that?

These kinds of things are amazing.

So if you can get to know your legislators, try a different angle than you might have

been taught so far.

You know, there's the DO on the hill day.

There's those big events.

You do that stuff.

You have to do it for the profession.

But when nobody's looking, if you can make a one-on-one relationship, the elected official

and really get to know that person and offer to help them on their other stuff, it'll pay

off in spades.

You really, really, really can make effective change because they'll listen to you.

All right.

I've got two kind of grand finale questions for you.

What is the best piece of advice that you have received, whether it be in like grade

school, medical school, residency, postgraduate training, and what is that one thing that

you can share with our listeners and you think that would give people the most value?

Wow.

That's a million-dollar question right there, isn't it?

That's right.

Man, I wish I had something kind of queued up for that.

That's one of those questions I'm going to think of like at 2 in the morning.

I'm going to sit up tonight and say, oh, of course it was blah, blah, blah.

There's two things that come to mind immediately, and one is really, really frustrating.

One of them is, I've talked a lot about my dad.

My mom, by the way, is a retired schoolteacher, dad's an anesthesiologist, so I guess that's

how you make a child psychiatrist, right?

One of the most profound things that I was ever told, and it's the most frustrating thing,

because wouldn't we all like to have had a parent tell us what to do for our jobs so

that we could say no, right?

The one thing my dad never did was to say, I'm an anesthesiologist, and even when you're

a third year's medical student, I'm the head of them in the country.

You need to be an anesthesiologist.

I wish he had said that because then I could have said, no, you can't tell me what to do.

I'm going to blaze my own trail, blah, blah, blah, blah.

But you know what my dad said because he's such a wise and kind and thoughtful person?

He said to me, you can do whatever you want.

I don't even care if you graduate medical school.

You can go self-dosed.

That was such amazingly wonderful advice that it's the most frustrating thing I've ever

heard because what he was saying is, you go blaze your own trail.

You can do what I did.

You can do whatever.

It's kind of like an inverse of what you meant.

It's like the antithesis of advice.

It was somebody giving me a complete void of, do whatever you want.

If you go to those national conventions, you know, there's I don't know how many thousands

of people that go and there's usually a ceremony at each national for all medical specialties.

There's one happening, you know, at almost any given time and then the gavel will change

from whoever's the president to the next incoming president.

As my dad was wrapping his up in the year, I think he was 2000 to 2001 when I was a medical

student and you go to this event and there's like a thousand anesthesiologists in the national

convention and they were passing the gavel to the incoming anesthesiologist that was

taking over and the outgoing person would always introduce their family in the back

of the room and you kind of wave and there you are.

And my dad said, and I was the last in the row of my family, my dad said, and there's

my son.

He's currently a third year student and when he said I was a medical student, everyone

started to clap and I could tell what just happened.

Oh, my dad mentioned that I had joined the medical student membership of the ASA.

I got a standing ovation.

I have no intention.

But what was so cool about this, the next president, he now took over, took the gavel

and he introduced, you know, his family and such.

And you know, before he began his address, he said, where's Mackenzie's kid?

Stand up again.

And I was in the back of this auditorium, this huge, like three movies theater size,

you know, big, big, big room.

And I stood up.

I'm a med student.

And he looked at me and he said, hey, I just want you to know before I take over, your

dad's a great guy and, you know, it'll be hard to follow him.

But I just want you to know, my psychiatrist is really good to me.

And then he started his talk.

And I thought that was a really brave, amazing thing for somebody to say as they were about

to address this national organization.

He gave a nod to a psychiatrist and said such a touching and touching thing.

And that's really, really cool.

And that's where it's at.

Because back to what I was talking about, I think everything has a biologic chemical

cause.

We just don't know what they are yet.

And until we do, there's so much stigma.

For somebody to say that is just an amazingly brave thing.

And more of like a cute story was when Richard Martini, my mentor, I have his phrase on a

post-it note on my refrigerator, and it says, this is so nerdy, it says, no child is psychotic

unless they're alone and psychotic.

And that's a story where I'm sure I've been fooled before.

But this is the only time that someone faked their symptoms and then told me.

I'm sure it's happened to me other times.

But everybody in their lives and their career will at some point have a story where you

were so sure you were right in a certain situation.

And my boss and my mentor was telling me, no, no, no, you're wrong.

And we all had those.

It's almost like off of a television show.

I'm like, no, this time I'm right.

You don't know.

This is what I know.

And I was wrong.

And do you remember when we were talking earlier and I said I used to enjoy, well, I still

enjoy it.

I just don't work in a hospital anymore.

But I like to think of all the different causes of hallucinations, be it metabolic, endocrine,

neurologic, and you run this list.

And one of them is vascular.

So I've always been looking for someone that has vascular cause of hallucinations, and

that would be lupus.

They used to call it lupus cerebritis when I was a student.

I think they call it CNS lupus now.

You have inflamed blood vessels and they would push on structures and you would hallucinate.

Well, the ER called me once and there was a boy and they was howling like a dog and

barking and doing woof noises and, you know, lunging at people and trying to bite them.

And his father was holding him back.

This great big dad was holding this kid back.

And the ER called me and they said, hey, we don't really even need you to do a consult.

This kid has an uncle with CNS lupus and we're pretty sure this kid has the same thing.

So we're going to get an MRI just to double check.

We knew you've been looking.

So if you want to see this kid, maybe you can write it up.

And I called my mentor and I told him the story and I said, hey, there's a kid here

with, I think he's got to have CNS lupus.

We're going to publish it.

Now I've done one in each category.

I've finally done it.

And my mentor said, wait a minute, you said his dad is holding him?

I said, yeah.

And he goes, no, no, no, no, no.

You got to interview this kid without his parent in the room.

I said, no, you don't understand.

If the dad lets him go, he's going to bite me.

That's when Rich Martini said the quote that I wrote down and put it on my refrigerator.

No child is psychotic unless they're alone and psychotic.

And any smart high school student or beyond person can figure out what happened when the

dad left the room.

The kid stopped barking like a dog, jumped up on the exam table.

He looked at me and he said, where's my dad?

I said, he's going to the waiting room.

I go, what happened to the barking?

And this kid looked at me and said, do you have any idea how hard it is to fake that

you're a dog for that long?

He said, well, I'd knocked the bully over today on the playground at school.

And the kid looked at me and he gave me that motion where you do your pointer finger under

your neck like that you're dead.

And the kid said, all I knew is I had to get out of school for the rest of the year.

And he said, my uncle has this thing called lupus and he can't go to work because he

hears dogs.

So I thought if I just start making dog noises, they'll send me home.

But they took me here.

Now, how am I going to get out of this?

And that was one of my stories and I had, of course, told everybody in the emergency

room that I'm probably going to get bit by a dog, but I'm going to come out of this with

a publication.

So that's one of my other most profound quotes of my life.

Nobody is psychotic unless they're alone and psychotic.

Yeah.

And then final question for you.

Can you tell us what is your superpower?

And what I mean by that is just something that you feel like you own or you have or

is a part of you that makes you successful.

I'm not sure I'm successful.

However, I know I belong.

I'd say that's a definition of success.

Yeah.

I guess you're right.

Yeah.

It's not a paycheck.

It's funny in these condo buildings how it stratifies wealth by floor.

I hadn't really thought about it so much until we started to talk.

I'm kind of in the middle.

Hans the Rapper lives in my condo building.

So he's half my age, but he lives 20 floors above me.

So it's kind of funny.

See, that's success.

And so I don't know how I'm talking to you about Hans the Rapper right now, but if I

claim to be someone that cares about children and the emotional health of kids, and there's

a famous rapper that lives in my building, and he lives on the top floor, and he earned

it.

He should live there.

It's a wonderful thing.

But what's so funny about condos, as I'm sure you know and people know, it doesn't matter

if you live in the penthouse or on the bottom, the elevator, by sex, it's the common denominator.

So when Hans the Rapper and his friends get into their elevator, and then they wanna go

down to the street, why I might have hit the down button on my floor, now they've got to

tolerate me coming in the elevator with them, as happens every month or so, and boy, do

I try not to fanboy.

But what's so interesting is I think I help kids.

Now he donates millions of dollars to the Chicago Public School.

Who's helping kids?

You know what I mean?

So there's so many ways to think.

Do I think I'm successful?

Yeah, I really, really do.

Because I've helped individual kids that when I'm closing my eyes at night, I can think

of children, you know, specific kids in my life that, you know, will thank me for helping

them.

And it's not always what you think.

And one thing I'm sure of is, looking back, it's not how many milligrams of Prozac or

whatever.

It was the kid that I helped him with his chemistry homework the other day.

Because he was just gonna let it go, get an F, redo it, and the folks struggle with English

and the test questions were in.

And he had nobody else to ask.

So I called this kid and I guess that's successful, right?

You know what I think?

Honest to God, if I'm successful, if someone else said I'm successful, I'll tell you why

I think that's so.

Is I don't think, I hope that I'm hitting somebody's heart out there who's listening.

I hope that there's another person out there like me who wasn't sure if they should become

a physician or not.

Wasn't that biochem major in college.

Wasn't sure exactly what to do.

Frustrated my advisors in college and my high school guidance counselor told me not to go

to college, said join the army.

So I think if I'm successful, not sure that I am, but if I am, I think what has helped

me become successful is I was never that hyper competitive.

I wanna be a doctor to make my mom and dad proud.

I was that person that thought about doing a whole bunch of other stuff, but I kept coming

back to it.

Like, you know what?

Gosh, I can't get rid of this feeling.

Let me go do it.

Let me go do it.

So if I'm successful, I think for me it's that I don't feel, I'm still amazed every

single day that I'm a physician and how cool this job is.

I think that could be a gift if anybody else feels like me.

One of the greatest things you can do is stay tenacious, keep at it, keep grinding and get

to the point where you can look at yourself in the mirror and think, I'm actually a doctor

here and I'm actually helping people.

I said to a teenage kid the other day on the phone that she was telling me how she's trying

to decide what to major in when she goes to college and I started to laugh and she said,

what?

And I said, well, I don't know if you've really thought of this before, but look at my job.

And she goes, what do you mean?

I said, I'm right now being paid by the state of Illinois to talk to you and you're a super

cool person.

I have a job where I'm talking to cool teenagers all day.

Think about that.

And the kid's like, yeah, you have a pretty cool job.

But I think I've never taken it for granted.

You're the one interviewing me, but if I flip it on you, did you have that experience in

your first year when you were taking anatomy or for me, it was histology, when the histology

instructor failed the entire class, did you have that experience at your school?

The entire class, but I've had my fair share of very challenging exams where everyone did

much poorer than they expected.

And then you remember there was that 19-year-old kid that somehow did high school and college

at the same time and is now in medical school as a prodigy and that person gets their first

not straight A grade for their entire life and bursts into tears and runs out and calls

an ambulance because they've never been in that situation before.

I was not that guy.

I was the guy that said, you can't fail us all.

I've been in this situation before, I can get through this.

I think there's something very advantageous about being a regular Joe or a regular Jill

and being a blue jeans personality person and just being shocked at how far you can

go as a regular person.

I know there's that imposter syndrome people talk about when you become a brand new doctor

and the first day you're at work as a brand new first day intern, an intern is the first

year of your residency and it happens to everybody.

Your first day of your first year as an intern, you've been a doctor for one hour and someone

yells for a code and somebody's having a seizure in front of you and your first thought is,

yeah, we got to get a doctor.

And then you realize, oh gosh, that's me.

You know, there's that.

But there's a deeper level that you can have where you make sure that you don't feel any

better than anybody else.

And I said this before, I want to make it clear to medical students and college kids

and high school kids, if you want to be a doctor, I don't want you to hear my voice

and think, wow, this guy is ahead of me and he's smarter than me.

I'm not any smarter than you at all.

The only difference between me and a kid who might be listening who's a 10th grader right

now, I was born before you.

That's it.

That's the only difference.

I've just had more go-rounds on the planet, you know.

So stay humble and keep grinding, I think is the words that I offer to anybody and be

a child psychiatrist.

I love it, I love it, well, thank you so much, Dr. McKenzie for taking the time.

This has been fantastic.

Can I take a moment to tell everybody there's another Jim McKenzie who's also a DO, who's

also a child psychiatrist.

My last name is MACK, Mac, I have the Scottish last name.

There's an MC, also a DO, he's got the Irish last name.

I've never met him.

He's probably done now.

He did a child psychiatry fellowship at Lurie's where I used to work.

I only want to mention that just in case, by the way, that's one of the strangest things

I've ever heard in my entire life.

I would not even normally mention that.

I don't know, I've never met him.

I'm afraid to meet him because he's probably a genius, gorgeous, you know, amazing person,

you know, he's like my replacement.

I only mention that just in case anybody hears my voice and then someday you're at some psychiatry

convention and you run up to this guy who I've never met and say, hey, I heard you once

in a podcast and this guy would look at you like, wait, what?

So heads up, there's another person with my exact same name who's a DO with the same job.

Isn't that the weirdest thing you've ever heard?

That is wild, yeah.

It is wild, right?

So anyhow, go DO and you can do anything that the MDs can do and you don't worry about stigma.

Any place that gives you a hard time, you don't want to be there anyhow because that

tells you a lot about that place.

You know, I've never experienced that yet in my career.

You know, so it certainly isn't Mayo Clinic, it certainly isn't Northwestern, it certainly

isn't Rush, it certainly isn't Liola and Harvard Medical School recruited me years ago to work

at Boston Children's to do their ER consult, you know, stuff.

I ended up wanting to stay in Chicago, but I tell that to people that listen, if you're

worried about some little hospital program in some state, somewhere in the United States,

yet Harvard Medical School in Boston says, no, that's great.

Come on in.

We love DOs.

That's good.

Right?

So don't worry, you know.

Now, again, it might be different if you want to be an eyeball surgeon.

I don't know.

Maybe they're so competitive that they just, but I think that's more of an artifact of

they're so competitive.

It's not that they're against DOs, they get 10,000 applicants for their five seats.

They don't even get to the DOs.

You know what I mean?

Yeah, right.

This concludes our episode of Do or Do Not.

Send all inquiries, comments, suggestions, and even let us know if there's someone you

want us to interview to do or do not podcast at gmail.com.

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We have plenty of more interviews lined up and we're excited to share them with you.

This is Tianyu Shen.

Thank you guys so much for listening to Do or Do Not.